Chapter Three
On Matters of Milk and Motherhood
Promoting Public Health in the Private Sphere
Concerns about children’s health mounted as infant mortality rates were rising rather than falling by the end of the nineteenth century and the threat of summer diarrhea increasingly became a major concern for Medical Officers of Health. They understood the causal factors at play, but across the three cities the Medical Officers were conflicted about how to respond to the threat of summer diarrhea. While sanitary reforms sought to reduce the breeding of flies, it was quite clear that the real epicenter of summer diarrhea existed inside the ill-ventilated, unsanitary homes of the working classes. Arthur Newsholme, then Medical Officer of Health in Brighton, who would later become the Chief Medical Officer of the Local Government Board, first articulated this point in 1894. He later recalled in his memoirs that “the chief means of preventing diarrhea will remain with the householder,” especially one who maintained “domestic cleanliness” and took “care in preparation of infants’ food.”
1Newsholme, Fifty Years in Public Health, 323. Yet, while the Medical Officers of Health would often disseminate notices about matters of domestic hygiene to working-class mothers, it is unclear how effective these were. According to medical historian Valerie Fildes, most Medical Officers of Health “were convinced that mothers did not read them or, if they did, disregarded the instructions and relied on the advice of female relatives and neighbors.”
2Fildes, “Infant Feeding Practices and Infant Mortality in England,” 253.So, the key to making serious headway against summer diarrhea required a more direct intervention into the English household. This required a very different approach to public health than large-scale Chadwickian sanitary engineering. Gaining access to the English household, even to promote
public health, was tricky, and crossing the line between public and private life was difficult.
3While these concepts provide a useful rhetorical separation to think about the home as a physically distinct ecological space, Koven, “Borderlands,” 96, reminds us that women working publicly or privately towards the advancement of welfare were able to move with such fluidity between the private/domestic and public “spheres,” which highlights the problematic “artificiality of bipolar constructions of these categories.” It was one thing to redevelop housing at the municipal level to improve the living conditions of working-class Britons, but a direct intervention inside English homes was often met with resistance from a working-class public that was skeptical of coercion and interference from a middle-class (and predominantly male) public health authority imposing its values and assumptions about good motherhood on them.
4Mooney, Intrusive Interventions, 5.One notable solution emerged, however, as middle-class
women began to take ownership of and the responsibility for domestic sanitation, breaking down the highly gendered line between
public health and
private life.
5Addams, Architecture in the Family Way, 73; see also Tomes, The Gospel of Germs, for a parallel American history. Reading advice manuals like Harriette Plunkett’s
Women, Plumbers and Doctors, middle-class women became inspectors of their own homes, monitoring for the four Ds they were told to avoid: Darkness, Dampness, Dirt, and Disease.
6Addams, Architecture in the Family Way, 82. The Medical Officers of Health embraced this partnership, and, by the 1890s, would begin to hire women into their staff. These female health visitors would become the key to unlocking access to working-class households, a task that first began as an act of private charity and would in turn allow public health officials to continue their campaign to curb diarrhea and reduce infant mortality.
After considering the emerging science of the biochemistry of milk, which was critical to a child’s healthy development but also a major vector for the spread of diarrheal pathogens, we will turn our attention to ways in which the Medical Officers of Health gained access to the British home through the appointment of professional lady health visitors to their staff. Health visitors conducted door-to-door visiting to the homes of reported births, where they would inspect the hygienic conditions of the premises and offer lessons in motherhood and healthy childrearing directly inside the home.
7Marks, “Mothers, Babies and Hospitals,” 49. In so doing, these women played a crucial role in the campaign to curb summer diarrhea by expanding the scope of public health into the domestic sphere, while greatly increasing the reach of the state into the lives of individual Britons.
At the same time, it should be noted, this role also created new professional opportunities for middle-class (and later for working-class) women outside the confines of their personal domestic space, in a nursing-adjacent profession. Philanthropy was a natural outlet for middle-class women, who believed that they could leverage their experience and education to do good work outside the home throughout much of the Victorian era.
8Prochaska, Women and Philanthropy in Nineteenth-Century England, 7. Charitable work targeting children was enormous, and house-to-house visiting was an important example. However, while health visiting began as an act of charity, by the last decade of the nineteenth century it became a paid professional position reporting to the Medical Officers of Health.
9Prochaska, Women and Philanthropy in Nineteenth-Century England, 75.